Pediatric emergency medicine trisk 2131 2131
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identifiable cause. Genital discomfort, discharge, itchiness, and dysuria are
relatively common childhood complaints. In a reported series of premenarcheal
girls with vaginitis who have been systematically evaluated, between 25% and
75% are ultimately categorized as having nonspecific vaginitis. The diagnosis
should not be made until other entities have been excluded through examination
and testing if indicated
Clinical Assessment
When a prepubertal girl with vaginitis symptoms has either a normal vulva and
vagina or only mild vulvar inflammation on physical examination, a specific
vaginal infection is unlikely, and other possible explanations for the complaint—
smegma, pinworms, urinary tract infection, a local chemical irritant, or sexual
abuse, for example—should be sought with appropriate questions and laboratory
tests. (It should be noted that commercially available bubble bath is not often the
culprit.) If, however, a vaginal discharge is present on physical examination, the
specific vaginal infections discussed in this chapter are diagnostic possibilities
and cultures or other specific testing should be obtained.
Management
General measures to promote cleanliness and comfort should be initiated for the
girl with nonspecific vaginitis. Daily soaking in a bath of warm water, either plain
or with some baking soda added, gentle perineal cleaning with a soft washcloth,
and the use of cotton underwear can be recommended. The girl should be taught
to wipe toilet paper anteroposteriorly. Using these suggestions, most girls with
perineal irritation will show improvement within 2 weeks. The remaining patients
should be reevaluated to exclude any specific but previously unrecognized
disorder. If none is found, these girls may benefit from a brief course of topical
estrogen cream (a small amount dabbed onto the vulva nightly for 2 to 4 weeks)
to stimulate thickening of the vaginal mucosa so that it is more resistant to local
irritation. Parents should be cautioned that estrogen cream is capable of producing
breast growth and tenderness if it is used for a prolonged period of time.
CERVICITIS
Goals of Treatment
To identify the causative agent and treat with antibiotics or removal of offending
agent as appropriate, patients should also be screened for other sexually
